Patient care modifications and hospital regulations during the COVID-19 crisis created inequality and functional hazard for patients with orthopaedic trauma

Abstract

Purpose The COVID pandemic has decreased orthopaedic fracture operative intervention and follow-up and increased the use of virtual telemedicine clinics. We assessed the implications of this management on future orthopaedic practice. We also surveyed patient satisfaction of our virtual fracture follow-up clinics. Method We prospectively analysed 154 patients during two weeks of 'lockdown' assessing their management. We surveyed 100 virtual fracture clinic follow-up patients for satisfaction, time off work and travel. Results Forty-nine percent of patients had decisions affected by COVID. Twelve percent of patients were discharged at diagnosis having potentially unstable fractures. These were all upper limb fractures which may go onto mal-union. Twenty-nine percent of patients were discharged who would have normally had clinal or radiological follow-up. No patients had any long-term union follow-up. Virtual telemedicine clinics have been incredibly successful. The average satisfaction was 4.8/5. In only 6% of cases, the clinician felt a further face-to-face evaluation was required. Eighty-nine percent of patients would have chosen virtual followup under normal conditions. Conclusion Lessons for the future include potentially large numbers of upper limb mal-unions which may be symptomatic. The non-union rate is likely to be the same, but these patients are unknown due to lack of late imaging. Telemedicine certainly has a role in future orthopaedic management as it is well tolerated and efficient and provides economic and environmental benefits to both clinicians and patients.

Telemedicine trends in orthopaedics and trauma during the COVID-19 pandemic: A bibliometric analysis and review

“…Fifty-nine articles met the inclusion criteria and were considered for the analysis. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 The excluded thirty-four papers were editorials, letters, duplicate entries, and articles with no discussion on telemedicine even in the full text ( Figure 1 ). The monthly contributions trend of the orthopaedic telemedicine-related articles is shown in Figure 2 .…”

“… 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 Telemedicine can address the general and specialised needs of osteoporotic patients, paediatric deformities, fracture patients, and sports injuries. 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 High patient and doctor satisfaction has been recorded with telemedicine. 26 It is found to be helpful in decision-making and telephone-based follow-up care.…”

Changes in trends of orthopedic services due to the COVID-19 pandemic: A review

“…Dunkerley et al [ 21 ] noted that the pandemic has decreased operative intervention of unspecified upper extremity fractures and increased the use of telemedicine clinics. In this prospective study which was performed at the peak of the COVID-19 outbreak from April 14 through April 28, 2020, of the 154 patients that were analyzed, 51% were managed as in a normal circumstance, whereas 49% of managements were impacted by the pandemic.…”

Evolving Practice in Management of Pelvic-Acetabular Trauma: COVID-19 Experience From a Tertiary Referral Centre in the UK

“…There is significant focus on the recently published literature on how surgical practice, including Orthopaedic Surgery, has evolved across the globe due to the pandemic [ 11 , 12 ]. However, usually, the authors study these practices and compare them with Pre-COVID times, which we believe is of incredible value in its own right.…”